Dr R Beynon University Hospital of North Staffordshire

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Management • Pt discharged with regular flecainide • Readmitted for planned GA case 2 months later • 3 consultant procedure, myself, colleague and visiting consultant with epicardial experience
EPS and attempted ablation • TV annulus remapped with SRO sheath, F curve cool tip catheter • AF spontaneously induced with degeneration to VF – cardioverted to SR • Prolonged mapping at TV annulus with early signals at 6 o’clock. • Multiple ablations with occasional suggestion of a change in the degree of pre-excitation. • Good signals up to 40 msec ahead of delta over a reasonably wide area. • Eventually exchanged SR0 for an Agilis sheath to get better contact and perform • Further ablation without success.
Page 1 and 2: A challenging case early on Rhys Be
Page 3 and 4: 12 Lead ECG
Page 5 and 6: Anterograde curve
Page 7 and 8: Antidromic tachycardia with CL 230m
Page 9 and 10: Shortest RR interval in AF 160 msec
Page 12 and 13: Management • 3 External DC shocks
Page 14 and 15: Clinical course • Pt spontaneousl
Page 16 and 17: Management • Initial attempt to a
Page 18 and 19: Pathway mapped to between 6 and 7 o
Page 22 and 23: Epicardial access gained
Page 24 and 25: Endocardial mapping extended AGAIN
Page 26 and 27: Eventual ablation site
Page 28: Conclusions • EP studies and abla

Dr R Beynon University Hospital of North Staffordshire

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